ICD-10 Coding for Fractured Hip(S72.001A, M80.051A)
Complete ICD-10-CM coding and documentation guide for Fractured Hip. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fractured Hip
S72.0-S72.9Primary Range
Fractures of femur
This range includes all types of femoral fractures, including those of the hip.
Osteoporosis with pathological fracture
Used when the fracture is due to osteoporosis, indicating a pathological fracture.
Periprosthetic fracture around internal prosthetic joint
Used for fractures occurring around a hip prosthesis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S72.001A | Fracture of unspecified part of neck of right femur, initial encounter | Use for initial encounters of unspecified femoral neck fractures without underlying pathology. |
|
| M80.051A | Osteoporosis with current pathological fracture, right femur | Use when the fracture is due to osteoporosis, confirmed by bone density tests. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for fractured hip
Essential facts and insights about Fractured Hip
Primary ICD-10-CM Codes for fractured hip
Decision Criteria
clinical Criteria
- Confirmed traumatic fracture without underlying pathology
documentation Criteria
- Includes laterality and fracture type
Applicable To
- Traumatic fracture of femoral neck
Excludes
- Pathological fracture due to osteoporosis (M80.0-)
Clinical Validation Requirements
- X-ray or CT confirming fracture
- Mechanism of injury documented
Code-Specific Risks
- Risk of using unspecified code without laterality
Coding Notes
- Ensure documentation specifies laterality and fracture type.
M80.051A - Osteoporosis with current pathological fracture, right femur
Use when the fracture is due to osteoporosis, confirmed by bone density tests.
Applicable To
- Pathological fracture due to osteoporosis
Excludes
- Traumatic fracture (S72.0-)
Clinical Validation Requirements
- DXA scan with T-score ≤-2.5
- Documentation of osteoporosis
Coding Notes
Link osteoporosis to the fracture with clinical evidence.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Periprosthetic fracture around right hip prosthesis
M97.01XADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fractured Hip to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.001A.
Impact
Clinical: Leads to incorrect treatment tracking, Regulatory: Non-compliance with coding standards, Financial: Potential for incorrect billing
Mitigation Strategy
Always include encounter type in documentation, Use templates that prompt for encounter details
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Always specify the exact location and laterality of the fracture.
Impact
High risk of audit if unspecified codes are used without justification.
Mitigation Strategy
Ensure all documentation includes specific fracture details and laterality.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Fractured Hip, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fractured Hip
Use these documentation templates to ensure complete and accurate documentation for Fractured Hip. These templates include all required elements for proper coding and billing.
Elderly patient with hip fracture due to osteoporosis
Specialty: OrthopedicsRequired Elements
- Fracture type and location
- Laterality
- Underlying conditions
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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